Skip Navigation

JNCI Journal of the National Cancer Institute 1993 85(22):1839-1844; doi:10.1093/jnci/85.22.1839
© 1993 by Oxford University Press
This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Ajani, J. A.
Right arrow Articles by Stablein, D. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ajani, J. A.
Right arrow Articles by Stablein, D. M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Journal of the National Cancer Institute, Vol. 85, No. 22, 1839-1844, November 17, 1993
© 1993 Oxford University Press

Preoperative and Postoperative Combination Chemotherapy for Potentially Resectable Gastric Carcinoma

Jaffer A. Ajani, Robert J. Mayer, David M. Ota, Glenn D. Steele, Douglas Evans, Mark Roh, David J. Sugarbaker, Pamela Dumas, Catherine Gray, Donald A. Vena, Donald M. Stablein

The University of Texas M. D. Anderson Cancer Center Houston
Dana-Farber Cancer Institute Boston, Mass.
The EMMES Corporation Potomac, Md.

Correspondence to: Jaffer A. Ajani, M.D. Department of Gastrointestinal Oncology, Box 78, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030

Background: Median survival of patients with local-regional gastric carcinoma is 10 months. Resection of the primary tumor and regional lymph nodes, with tumor-free margins (curative resection), has been the most effective treatment for local- regional gastric carcinoma. However, median survival of patients with curative resection of gastric carcinoma is 24 months, and the 5-year survival rate is about 20%. A single institution pilot study has established the feasibility of administering two courses of chemotherapy preoperatively and three courses postoperatively. In another study, a 15% pathologically documented complete response (pathologic complete response) has been reported in unresectable gastric carcinoma treated with etoposide, doxorubicin, and cisplatin. Purpose: Our purpose was to increase the curative resection rate in potentially resectable gastric carcinoma and to delay or eliminate micrometastases and thus improve survival. We also evaluated clinical and pathologic response to chemotherapy. Methods: Forty-eight previously untreated patients with potentially resectable gastric carcinoma received a chemotherapy regimen (EAP) consisting of etoposide (120 mg/m2 intravenously over a 2-hour period on days 4, 5, and 6), doxorubicin (20 mg/m2 as a 10-minute intravenous infusion on days 1 and 7), and cisplatin (40 mg/m2 as a 1-hour intravenous infusion on days 2 and 8). Patients received three courses of chemotherapy before resection, and responding patients received two courses postoperatively. Clinical and pathologic response rates, toxicity, patterns of treatment failure, and survival times were assessed. Results: A median of three courses (range, 1-5) of preoperative therapy was administered; six (12%) of the 48 patients had clinical complete response, and nine (19%) had partial response. Forty-one (85%) underwent surgery; 37 (90%) of these 41 (77% of the 48 patients) had a curative resection. There were no pathologic complete responses. Median survival for all patients is 15.5 months (range, 2–29+ months). Therapy was discontinued because of the toxic effects in one patient before surgery and in six patients after surgery. Doses were reduced in 37 patients (77%), mainly because of hematologic toxicity. Nineteen (40%) were hospitalized because of toxic effects, including 15 patients who developed fever with neutropenia. Grade 3 or 4 nausea and vomiting occurred in 15 patients and grade 3 or 4 diarrhea in seven patients. One death was directly related to chemotherapy. Conclusions: These data support that administration of preoperative and postoperative chemotherapy for local-regional gastric carcinoma is feasible in a multi-institutional setting. Our findings demonstrate that this EAP regimen is modestly active but is associated with substantial toxicity. Implications: Use of preoperative chemotherapy in resectable gastric carcinoma merits further evaluation, but more effective drug regimens will be required before a controlled trial is initiated. [J Natl Cancer Inst 85:1839–1844, 1993]


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 JCOHome page
L. Lim, M. Michael, G. B. Mann, and T. Leong
Adjuvant Therapy in Gastric Cancer
J. Clin. Oncol., September 1, 2005; 23(25): 6220 - 6232.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
J.A. Ajani, P.F. Mansfield, N. Janjan, J. Morris, P.W. Pisters, P.M. Lynch, B. Feig, R. Myerson, R. Nivers, D.S. Cohen, et al.
Multi-Institutional Trial of Preoperative Chemoradiotherapy in Patients With Potentially Resectable Gastric Carcinoma
J. Clin. Oncol., July 15, 2004; 22(14): 2774 - 2780.
[Abstract] [Full Text] [PDF]

Home page
 Ann OncolHome page
A. D. Roth, A. S. Allal, M.-A. Brundler, R. de Peyer, B. Mermillod, P. Morel, and O. Huber
Neoadjuvant radiochemotherapy for locally advanced gastric cancer: a phase I-II study
Ann. Onc., January 1, 2003; 14(1): 110 - 115.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
J. A. Ajani, P. F. Mansfield, P. M. Lynch, P. W. Pisters, B. Feig, P. Dumas, D. B. Evans, I. Raijman, K. Hargraves, S. Curley, et al.
Enhanced Staging and All Chemotherapy Preoperatively in Patients with Potentially Resectable Gastric Carcinoma
J. Clin. Oncol., August 1, 1999; 17(8): 2403 - 2403.
[Abstract] [Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.